Department of Urology, Zagazig University, Faculty of Medicine, Zagazig, Sharkia Governorate, 44519, Egypt.
Department of Urology, Zagazig University, Faculty of Medicine, Zagazig, Sharkia Governorate, 44519, Egypt.
J Pediatr Urol. 2022 Jun;18(3):366.e1-366.e9. doi: 10.1016/j.jpurol.2022.04.001. Epub 2022 Apr 18.
In re-operative hypospadias repair, scarred urethral plate, and deficient unhealthy penile skin are usually problematic. Difficulties are not only in urethroplasty but also in penile skin coverage. Penile skin coverage after urethroplasty with good viable skin decreases the complication rate and increases the satisfaction with repair. Studies reporting variables that increase the risks of the need for penile resurfacing in re-operative hypospadias are lacking.
To determine the risk factors of the need for penile resurfacing techniques (PRSTs) in re-operative hypospadias.
A retrospective analysis of the redo hypospadias cases operated in-between January 2010 and December 2020 was done. Surgical data of the previous repairs, the indications for intervention, and the penile shaft coverage techniques at the time of the last repair were collected and analyzed. Patients' records were reviewed and categorized into two main groups. Group one include patients with simple skin closure, and group two include patients in whom penile resurfacing was done. Univariate analysis and Stepwise logistic regression measured the risk factors of the need for penile resurfacing techniques.
Out of 223 re-operative hypospadias, simple skin closure was done in 105 (group 1). Penile skin resurfacing (Byars flaps, Heineke-Mikulicz technique, and Z-Plasty) was in 55 (group 2a). In 63 patients (group 2b), scrotal flaps and skin grafts (split and full thickness) were the PRSTs. Patients ages, proximal hypospadias, number of prior surgery, one-stage repair, penile skin use in repair especially flap techniques, more than one complication in the same case, and unsatisfactory skin appearance increased the risk for PRSTs. Each previous repair increases the odds ratio of penile and non-penile resurfacing 1.9 and 3.2 folds respectively. One-stage repair increases odds of PRSTs 4 folds.
We analyzed the risk factors of the need for penile resurfacing techniques in the re-operative hypospadias cases. Step-wise logistic regression showed that the number of previous repairs and one-stage repair are the independent risk factors of penile resurfacing. Also, it showed that the number of prior surgeries is the only independent risk factor for non-penile skin resurfacing.
Number of previous repair is the independent risk factors of penile resurfacing and non-penile skin use in resurfacing. Previous repair in one-stage is an independent risk factor of the need for penile resurfacing.
在修复性尿道下裂手术中，瘢痕化的尿道板和不健康的阴茎皮肤通常是个问题。不仅在尿道成形术中存在困难，而且在阴茎皮肤覆盖方面也存在困难。在尿道成形术后使用有活力的皮肤进行阴茎皮肤覆盖可以降低并发症的发生率，提高修复满意度。目前缺乏报告增加修复性尿道下裂中需要阴茎表面重建技术（PRST）风险因素的研究。
确定修复性尿道下裂中需要阴茎表面重建技术（PRST）的风险因素。
对 2010 年 1 月至 2020 年 12 月间进行的修复性尿道下裂病例进行回顾性分析。收集并分析了之前手术的手术数据、干预指征以及上次修复时的阴茎干覆盖技术。回顾患者记录并分为两组。第一组包括单纯皮肤闭合的患者，第二组包括进行阴茎表面重建的患者。单因素分析和逐步逻辑回归测量了需要阴茎表面重建技术的风险因素。
在 223 例修复性尿道下裂中，105 例（第 1 组）行单纯皮肤闭合。55 例行阴茎皮瓣覆盖（Byars 皮瓣、Heineke-Mikulicz 技术和 Z 成形术）（第 2a 组）。在 63 例患者（第 2b 组）中，阴囊皮瓣和皮肤移植（部分和全厚）是 PRST。患者年龄、近端尿道下裂、手术次数、一期修复、阴茎皮肤在修复中的使用，尤其是皮瓣技术、同一病例中出现多个并发症、不满意的皮肤外观增加了 PRST 的风险。每次既往手术都会使阴茎和非阴茎表面重建的优势比增加 1.9 倍和 3.2 倍。一期修复使 PRST 的优势比增加 4 倍。
我们分析了修复性尿道下裂病例中需要阴茎表面重建技术的风险因素。逐步逻辑回归显示，既往手术次数和一期修复是阴茎表面重建的独立危险因素。此外，它还显示，既往手术次数是进行非阴茎皮瓣表面重建的唯一独立危险因素。
既往手术次数是阴茎表面重建和皮瓣使用的独立危险因素，一期修复是需要阴茎表面重建的独立危险因素。
